Emergence delirium in children: a Brazilian survey
Delírio de emergência em crianças: uma pesquisa brasileira
Vinícius Caldeira Quintão, Charlize Kessinde Oliveira Sales, Estefania Morales Herrera, Richard K. Ellerkmann, H. David Rosen, Maria José Carvalho Carmona
Abstract
Background
Pediatric emergence delirium is characterized by a disturbance of a child’s awareness during the early postoperative period that manifests as disorientation, altered attention and perception. The incidence of emergence delirium varies between 18% and 80% depending on risk factors and how it is measured. Reports from Canada, Germany, Italy, United Kingdom, and France demonstrated a wide range of preventive measures and definitions, indicating that there is a lack of clarity regarding emergence delirium. We aimed to assess the practices and beliefs among Brazilian anesthesiologists regarding emergence delirium.
Methods
A web-based survey was developed using REDCap®. A link and QR Code were sent by email to all Brazilian anesthesiologists associated with the Brazilian Society of Anesthesiology (SBA).
Results
We collected 671 completed questionnaires. The majority of respondents (97%) considered emergence delirium a relevant adverse event. Thirty-two percent of respondents reported routinely administrating medication to prevent emergence delirium, with clonidine (16%) and propofol (15%) being the most commonly prescribed medications. More than 70% of respondents reported a high level of patient and parent anxiety, a previous history of emergence delirium, and untreated pain as risk factors for emergence delirium. Regarding treatment, thirty-five percent of respondents reported using propofol, followed by midazolam (26%).
Conclusion
Although most respondents considered emergence delirium a relevant adverse event, only one-third of them routinely applied preventive measures. Clonidine and propofol were the first choices for pharmacological prevention. For treatment, propofol and midazolam were the most commonly prescribed medications.
Keywords
Resumo
Justificativa: O delirium do despertar pediátrico é caracterizado por um distúrbio da consciência da criança durante o período pós-operatório imediato que se manifesta como desorientação, atenção e percepção alteradas. A incidência do delirium do despertar varia entre 18% e 80%, dependendo dos fatores de risco e de como é medido. Relatos do Canadá, Alemanha, Itália, Reino Unido e França demonstraram uma ampla gama de medidas e definições preventivas, indicando que há falta de clareza em relação ao delírio de emergência. Nosso objetivo foi avaliar as práticas e crenças entre anestesiologistas brasileiros em relação ao delirium do despertar. Métodos: Uma pesquisa baseada na web foi desenvolvida usando REDCap®. Um link e QR Code foram enviados por e-mail para todos os anestesiologistas brasileiros associados à Sociedade Brasileira de Anestesiologia (SBA). Resultados: Coletamos 671 questionários preenchidos. A maioria dos entrevistados (97%) considerou o delirium do despertar um evento adverso relevante. Trinta e dois por cento dos entrevistados relataram administrar medicamentos rotineiramente para prevenir o delírio do despertar, sendo clonidina (16%) e propofol (15%) os medicamentos mais prescritos. Mais de 70% dos entrevistados relataram um alto nível de ansiedade do paciente e dos pais, uma história anterior de delirium ao despertar e dor não tratada como fatores de risco para delirium ao despertar. Em relação ao tratamento, trinta e cinco por cento dos entrevistados relataram usar propofol, seguido de midazolam (26%). Conclusão: Embora a maioria dos entrevistados considerasse o delirium do despertar um evento adverso relevante, apenas um terço deles aplicava rotineiramente medidas preventivas. A clonidina e o propofol foram as primeiras escolhas para prevenção farmacológica. Para o tratamento, propofol e midazolam foram os medicamentos mais prescritos.
Palavras-chave
References
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